Residential Treatment

These levels of care are applied based on assessments that analyze the degree of addiction, the risk of relapse into use, and the readiness of the individual to progress through treatment.

When a person’s continued substance use constitutes an immediate risk to that person’s mental or physical health, and there is a relatively high risk of relapse to use, the ASAM criteria recommend residential treatment as the appropriate level of care. This treatment level includes a range of different types of services that apply depending on the individual’s particular circumstances and needs.

Defining Residential Treatment

According to an article in Counselor magazine, the definition and understanding of residential treatment is the type of treatment required for people who, if they continue to use drugs or alcohol, are in imminent danger. However, imminent danger does not necessarily refer only to acute danger of life-threatening symptoms, such as seizure risk, or even the risks of mental or physical disease.

Imminent danger can mean that, because of continued substance abuse or addiction, the person is at risk of doing something that might put that person at risk at any time, such as driving while intoxicated. Another danger is that the person’s home life or other environmental influences continue to encourage substance use, making it more difficult for the person to stop this risky behavior.

Because of this variety of situations that constitute a need for residential treatment, there are a number of subcategories of care levels under the residential treatment level. These range from nonclinical residential settings that are designed to be more of a 24-hour supportive living arrangement, to fully clinical treatment programs with higher levels of clinical professional involvement.

Various Levels of Residential Care

Residential treatment is implied under Levels III and IV of the ASAM placement criteria, as described in the Substance Abuse and Mental Health Services Administration Treatment Improvement Protocols. Level III services include four subdivisions, which progress based on treatment intensity. The services should be considered part of a continuum of care, rather than separate care modalities. It is possible for people to progress down to lower levels of care if they complete certain goals during the higher level.

According to the ASAM Continuum online decision engine, summaries of these service levels include:

Level III.1: Clinically Managed Low-Intensity Residential Services: The low-intensity services include clinical therapy of at least five hours per week, and they have elements provided by medical and mental health personnel, but otherwise the treatment center staff are not medically trained. Still, these personnel have training to provide 24-hour support and structure to people in substance abuse treatment.

Level III.3: Clinically Managed Population-Specific High-Intensity Residential Services: These services are specifically designed to help people who have cognitive impairments or other conditions that may require a slower progress of care. These include the elderly, people with mental disabilities, and others who require more time to incorporate the elements of treatment. The treatment programs involve supervision by clinical therapists, and can include treatment for co-occurring disorders.

Level III.5: Clinically Managed High-Intensity Residential Services: In this level of service, 24-hour supervision by trained counselors is provided, with a full range of therapeutic treatment types available to help manage multiple imminent dangers. Again, this type of treatment can help those with co-occurring disorders.

Level III.7: Medically Monitored High-Intensity Inpatient Services: Continual nursing care with the availability of a treating physician is available under this level of care, able to provide medical treatment if needed during the program. Counselors are also onsite for support to help stabilize multiple imminent dangers, and co-occurring disorders can be treated.

Level IV: Medically Managed Intensive Inpatient Services: This highest level of intensity has round-the-clock nursing care and daily care with a medical doctor. This level of care is designed for the most acute dangers, and requires heavy supervision and an intense level of treatment.

Progressing through the Continuum of Care

As a person is able to meet goals in the level of care assigned, it is possible to move down to lower levels. The intent of the residential treatment levels of care is to prepare the individual to move down into outpatient treatment. At any time, however, if a person is unable to meet the goals of a care level, the individual may be transferred to a different element or a higher level again. This way, the person is given every opportunity to find the level of treatment that will enable the person to achieve long-term recovery.